急性心肌梗死后动脉粥样硬化性肾动脉狭窄与主要不良心血管事件的关联

Association of atherosclerotic renal artery stenosis with major adverse cardiovascular events after acute myocardial infarction.

作者信息

Zheng Bin, Liu Jinghua, Ma Qin, Zhao Donghui, Wang Xin, Zheng Ze

机构信息

Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.

Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China. Email:

出版信息

Chin Med J (Engl). 2014;127(4):618-22.

PMID:24534210

Abstract

BACKGROUND

Patients with atherosclerotic renal artery stenosis (ARAS) are in substantial risk of cardiovascular adverse events. We investigated whether myocardial infarction patients with ARAS are in additional risk of cardiovascular events.

METHODS

In this retrospective study, 257 patients with type 1 myocardial infarction were enrolled. Median follow-up was 42 months. Composite endpoint events are analyzed by definitions of ARAS as ≥ 50% or ≥ 70% diameter stenosis.

RESULTS

Defining ARAS as ≥ 70% diameter stenosis, ARAS was a significant predictor for composite endpoint events including death, non-fatal myocardial infarction, ischaemic stroke and intracranial haemorrhage, rehospitalisation for cardiac failure (HR: 4.381; 95% CI: 1.770-10.842) by Cox regression analysis, but not for death. Diabetes mellitus was also a significant predictor for composite endpoint events (HR: 2.756; 95% CI: 1.295-5.863). However, defining ARAS ≥ 50% diameter stenosis, ARAS was no longer a significant predictor for composite endpoint events or death.

CONCLUSIONS

Although not associated with mortality, ARAS ≥ 70% is associated with major adverse cardiac events after acute myocardial infarction. For prognosis, ≥ 70% diameter stenosis is a more appropriate criteria for ARAS definition than ≥ 50% diameter stenosis.

摘要

背景

动脉粥样硬化性肾动脉狭窄（ARAS）患者发生心血管不良事件的风险很高。我们研究了患有ARAS的心肌梗死患者是否存在额外的心血管事件风险。

方法

在这项回顾性研究中，纳入了257例1型心肌梗死患者。中位随访时间为42个月。根据ARAS定义为直径狭窄≥50%或≥70%来分析复合终点事件。

结果

将ARAS定义为直径狭窄≥70%时，通过Cox回归分析，ARAS是包括死亡、非致命性心肌梗死、缺血性卒中和颅内出血、因心力衰竭再次住院在内的复合终点事件的显著预测因素（HR：4.381；95%CI：1.770-10.842），但不是死亡的预测因素。糖尿病也是复合终点事件的显著预测因素（HR：2.756；95%CI：1.295-5.863）。然而，将ARAS定义为直径狭窄≥50%时，ARAS不再是复合终点事件或死亡的显著预测因素。